Alcohol’s cancer risk calls for policy review

THE world is taking note of ramifications of alcohol-related costs to the nations. In a recent article in The Lancet, the World Health Organisation (WHO) has warned that there is no ‘safe limit’ to alcohol consumption, and even a small amount may increase the risk of cancer.

Overall, alcohol consumption is linked to as many as 3 million deaths (5.3 per cent of all deaths) in the world each year. Younger people are disproportionately affected by alcohol compared with older people, and one in seven deaths among those aged between 20 and 39 years is attributed to alcohol. In 2020, alcohol was responsible for 7,40,000 cancer cases worldwide.

The National Family Health Survey-5 (NFHS-5) for 2019-21 revealed that nearly 15 crore people (over 15 years of age) consume alcohol in India (1.5 per cent of women and 18.8 per cent of men; 16.5 per cent in rural areas and 19.9 per cent in urban India). Alcohol consumption was the highest in Arunachal Pradesh (38.47 per cent), followed by Telangana (24.56 per cent) and Jharkhand (20.19 per cent). In Punjab, it was 11.9 per cent, Haryana 8.5 per cent, and in Chandigarh 9.84 per cent.

There has been an increase in alcohol consumption in India in the last three decades by close to 5.5 per cent in men over 15 years of age and to a smaller extent in women too.

The increase in consumption could be due to increased access and marketing, changing social acceptance, female empowerment and rising incomes. Alcohol consumption is no more a taboo and age is no longer a factor. Liberalisation of alcohol permits and licences for restaurants and bars has also contributed to the rising consumption. The average age of initiation has also come down.

Alcohol is widely known to cause liver cirrhosis and its resultant complications. The other major impact of alcohol consumption is accidents due to drunk driving. Alcohol is also linked to a number of other diseases like pancreatitis, alcoholic cardiomyopathy, stroke, alcohol dependence, psychiatric disorders, dementia, self-harm and interpersonal violence.

Most gastroenterology wards in public hospitals of north India are full of patients of alcoholic liver disease and alcohol-induced pancreatitis, both of which can be life-threatening and can financially ruin a family. Absenteeism, loss of productivity, social strife and domestic violence are also the negative effects of alcohol use. In addition, illicit alcohol may lead to blindness and even death. It has been seen that the ‘harm per litre’ is more to poor individuals than those affluent.

There is not much awareness about the link between cancers and alcohol. Apart from liver cancer, cancers of head and neck, pancreas, colon, esophagus and breast are also related to alcohol use, accounting to over 4 per cent of all cancers. The International Agency for Research on Cancer has classified alcohol as a high-risk carcinogen, together with radiation and smoking.

Alcohol is a ready cash cow for India, with each state trying to increase its revenue from alcohol by boosting sales. In some states, excise duty on alcohol contributes up to 25 per cent of all revenue. Punjab’s excise department collected over Rs 4,000 crore in the first six months of 2022 and the revenue collection increased by over 37 per cent. The government admitted that its twin objective was to maximise revenue and provide affordable liquor. Haryana also clocked an increase of Rs 1,000 crore in excise duty on alcohol in the first half of 2022.

A PGI study had projected the economic cost of alcohol consumption in India. By mathematical modelling, it was calculated that between 2011 and 2050, treatment of alcohol-related disease conditions will impose a burden of Rs 3,100 billion on the health system. The economic burden on society, out-of-pocket expenditure, productivity losses and health costs, all put together, amount to over Rs 1,20,000 billion and reflect a net economic loss of 1.45 per cent of the GDP per year to the Indian economy after taking account of revenue from sales. It needs to be kept in mind that this expenditure is borne by the families, industry, society, and not by the government. The current government spending on health is 1.2 per cent of the GDP.

While prohibition is in force in Bihar and Gujarat, we have permissiveness in other states with aggressive availability in states such as Punjab and Haryana. Some years ago, liquor availability on highways was curbed following a Supreme Court ruling, but it’s back to square one again. It is ironical that in some states, home delivery of alcohol is permitted, invoking the Disaster Management Act, 2005, on the pretext that crowding outside liquor stores can be unruly.

India needs to re-evaluate its approach towards alcohol. Admittedly, today we cannot prevent anyone from consuming alcohol, and revenue from alcohol is useful for developmental projects in the short term. However, in the long run, the economic burden of consequences of alcohol consumption far outweighs that. Since it is the young adults, especially males, who are affected the most, it is important to prioritise interventions targeted at these demographic groups.

The 75th World Health Assembly adopted the Global Alcohol Action Plan last year. It was pointed out that alcohol consumption is driven by ‘rampant and unrestricting advertising on social media and interference by the alcohol industry to influence policy decisions’. It called for generating public awareness on disease burden of alcohol, curtailing advertisements related to alcohol, and formulation of policies related to public health.

There is a need to educate people about the harmful effects of alcohol, much like what is done for smoking. Most patients with alcohol-related diseases do not fathom the gravity of situation they land in. All forms of alcohol advertisements, including surrogate ones, should be prohibited. Moving liquor vends away from the public glare can be a small but significant step. Drunk driving should be penalised heavily. It is equally important that states should not look merely at enhancing revenue from alcohol sales. Experts in public health and health economics should be involved in policymaking matters related to alcohol.